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https://www.readbyqxmd.com/read/28469888/an-alternative-technique-to-safely-close-the-chest-after-placing-a-child-on-central-venoarterial-extracorporeal-membrane-oxygenation
#1
Dimitrios Bobos, Meletios A Kanakis, Sofia Koulouri, Spyridon Rammos, Andreas Karabinis, Nicholas M Giannopoulos
Central venoarterial (VA) placement of extracorporeal membrane oxygenation (ECMO) is performed surgically, and in the majority of cases, the patient remains with an open sternum. Herein, a case of a 3-year-old patient who underwent insertion of a central VA ECMO for heart failure due to acute myocarditis is described. An alternative technique for ECMO placement providing sternal closure and minimizing infection risk for the safe patient transport is described.
May 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28458765/right-ventricular-perforation-from-a-floating-rib-following-deep-sternal-wound-infection-debridement-and-application-of-a-vacuum-assisted-closure-device-a-case-report-and-literature-review
#2
Amanda J Ross, Nada N Berry
Introduction: Deep sternal wound infection following major cardiac surgery is a deleterious complication with sequelae that can be life threatening. The use of vacuum-assisted closure therapy in management of sternal wounds with resultant right ventricular rupture has been documented in the cardiothoracic and to a lesser extent in the reconstructive literature. Methods/Case Report: We present a case of a 67-year-old male patient who suffered from right ventricular perforation from a floating rib following debridement of a deep sternal wound infection and placement of a vacuum-assisted closure device...
2017: Eplasty
https://www.readbyqxmd.com/read/28434547/stress-dose-corticosteroid-versus-placebo-in-neonatal-cardiac-operations-a-randomized-controlled-trial
#3
Pertti K Suominen, Juho Keski-Nisula, Tiina Ojala, Paula Rautiainen, Timo Jahnukainen, Johanna Hästbacka, Pertti J Neuvonen, Olli Pitkänen, Jussi Niemelä, Anu Kaskinen, Jukka Salminen, Risto Lapatto
BACKGROUND: Corticosteroids can improve the hemodynamic status of neonates with postoperative low cardiac output syndrome after cardiac operations. This study compared a prophylactically administered stress-dose corticosteroid (SDC) regimen against placebo on inflammation, adrenocortical function, and hemodynamic outcome. METHODS: Forty neonates undergoing elective open heart operations were randomized into two groups. The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6 hours after the operation, a hydrocortisone infusion (0...
April 20, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28402472/direct-sternal-administration-of-vancomycin-and-gentamicin-during-closure-prevents-wound-infection%C3%A2
#4
Martin Andreas, Moritz Muckenhuber, Doris Hutschala, Alfred Kocher, Florian Thalhammer, Paul Vogt, Tatjana Fleck, Guenther Laufer
OBJECTIVES: Deep sternal wound infection is still a major complication in patients undergoing cardiac surgery. We previously identified mammary artery harvesting as a risk factor for decreased antibiotic tissue penetration. In addition, other risk factors including diabetes may inhibit sufficient tissue penetration of perioperative antibiotic prophylaxis. A novel closure protocol applying 2 topical antibiotics and further recommendations for sternal wiring was introduced at our department to decrease the incidence of sternal wound infections...
April 10, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28376028/a-national-study-of-the-impact-of-delayed-flap-timing-for-treatment-of-patients-with-deep-sternal-wound-infection
#5
Erika D Sears, Adeyiza O Momoh, Kevin C Chung, Yu-Ting Lu, Lin Zhong, Jennifer F Waljee
BACKGROUND: This study aims to evaluate the impact of delayed flap closure on mortality and resource utilization for treatment of deep sternal wound infection (DSWI). METHODS: We analyzed the Truven MarketScan Databases from 2009 - 2013 to identify adult patients who developed DSWI after open cardiac surgery and who received flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing...
April 1, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28350561/reducing-pediatric-sternal-wound-infections-a-quality-improvement-project
#6
Claudia Delgado-Corcoran, Charlotte S Van Dorn, Charles Pribble, Emily A Thorell, Andrew T Pavia, Camille Ward, Randall Smout, Susan L Bratton, Phillip T Burch
OBJECTIVES: To evaluate whether a quality improvement intervention reduces sternal wound infection rates in children after cardiac surgery. DESIGN: This is a pre- and postintervention quality improvement study. SETTING: A 16-bed cardiac ICU in a university-affiliated pediatric tertiary care children's hospital. PATIENTS: All patients undergoing cardiac surgery via median sternotomy from January 2010 to December 2014 are included...
May 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28345371/ewma-document-negative-pressure-wound-therapy
#7
Jan Apelqvist, Christian Willy, Ann-Mari Fagerdahl, Marco Fraccalvieri, Malin Malmsjö, Alberto Piaggesi, Astrid Probst, Peter Vowden
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.(1) NPWT has been described as a effective treatment for wounds of many different aetiologies(2,3) and suggested as a gold standard for treatment of wounds such as open abdominal wounds,(4-6) dehisced sternal wounds following cardiac surgery(7,8) and as a valuable agent in complex non-healing wounds...
March 1, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28315287/elective-primary-or-secondary-delayed-sternal-closure-improves-outcome-in-severely-compromised-patients
#8
Antonio M Calafiore, Azmat A Sheikh, Juan J Alfonso, Tarek Tantawi, Belgeit Maklouf, Ahmed Shawki, Ahmed Allam, Mohammed O Awadi, Ahmed A Osman, Aly M Habib, Michele Di Mauro
Background Delayed sternal closure (DSC) in patients with severely compromised preoperative hemodynamics can be helpful as the chest sometimes cannot be able to contain both lungs and heart. We report our experience to evaluate the midterm results of this strategy in an adult population. Materials and Methods From May 2009 till July 2015, 33 patients had DSC as first treatment of severe hemodynamic deterioration after cardiac surgery. Surgical procedures were valvular (9.27%) or coronary artery bypass grafting + others (24...
March 17, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/28299880/rates-of-autism-and-potential-risk-factors-in-children-with-congenital-heart-defects
#9
Jessica L Bean Jaworski, Thomas Flynn, Nancy Burnham, Jesse L Chittams, Therese Sammarco, Marsha Gerdes, Judy C Bernbaum, Robert R Clancy, Cynthia B Solot, Elaine H Zackai, Donna M McDonald-McGinn, J William Gaynor
OBJECTIVE: Atypical development, behavioral difficulties, and academic underachievement are common morbidities in children with a history of congenital heart defects and impact quality of life. Language and social-cognitive deficits have been described, which are associated with autism spectrum disorders. The current study aimed to assess the rates of autism spectrum disorders in a large sample of children with a history of congenital heart defects and to assess medical, behavioral, and individual factors that may be associated with the risk of autism spectrum disorders...
March 16, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/28295610/internal-mammary-artery-pseudoaneurysm-following-a-robicsek-sternal-closure
#10
Ali Ayaon Albarrán, José Antonio Blázquez González, Teresa Hernández Cabrero, Elkin González Villegas
No abstract text is available yet for this article.
April 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28255152/follicular-thyroid-cancer-with-sternal-metastasis-challenges-and-outcomes
#11
M A Syazni, H S Gendeh, N R Kosai, A R Ramzisham, B S Gendeh, N H Basiron, F H Imran
Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps...
February 2017: Medical Journal of Malaysia
https://www.readbyqxmd.com/read/28112330/-surgical-site-infections-in-children-undergoing-cardiac-surgery-with-delayed-sternal-closure-case-control-study
#12
Javiera Retamal, Pedro Becker, Rodrigo González, Marcela Ferrés, Jaime Cerda, María I Riquelme, Regina Pérez, Cristián Clavería
INTRODUCTION: Surgical site infections (SSI) are an important cause of morbidity in pediatric cardiac surgery. Risk factors in patients requiring delayed sternal closure (DSC) are unknown. AIM: To report the rate of SSI in children undergoing cardiac surgery with DSC and determine the risk factors. METHODOLOGY: A retrospective case-control study, in patients younger than 15 years old undergoing cardiac surgery with DSC in our center between 2009 and 2010...
October 2016: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
https://www.readbyqxmd.com/read/28105408/predictors-of-prolonged-mechanical-ventilation-in-pediatric-patients-after-cardiac-surgery-for-congenital-heart-disease
#13
Avisa Tabib, Seyed Ehsan Abrishami, Mohammad Mahdavi, Hojjat Mortezaeian, Ziae Totonchi
BACKGROUND: The duration of mechanical ventilation (MV) is one of the most important clinical factors which predict outcomes in pediatric cardiac surgery. The prolonged mechanical ventilation (PMV) following cardiac surgery is a multifactorial phenomenon and there are conflicts regarding its predictors in pediatric population between different centers. OBJECTIVES: The current study aimed to describe PMV predictors in patients undergoing cardiac surgery for congenital heart disease in a tertiary center for pediatric cardiovascular diseases in Iran...
August 2016: Research in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28068786/topical-and-low-dose-intravenous-tranexamic-acid-in-cyanotic-cardiac-surgery
#14
RANDOMIZED CONTROLLED TRIAL
Jigar Patel, Mrugesh Prajapati, Hardik Patel, Hemang Gandhi, Shilpa Deodhar, Himani Pandya
Background Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both. Methods Seventy-five patients were divided in 3 groups of 25. Group A patients were given tranexamic acid 20 mg kg(-1) intravenously after sternotomy and 20 mg kg(-1) after heparin reversal...
February 2017: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/27987229/neuronal-damage-biomarkers-in-the-identification-of-patients-at-risk-of-long-term-postoperative-cognitive-dysfunction-after-cardiac-surgery
#15
W F Kok, J Koerts, O Tucha, T W L Scheeren, A R Absalom
Biomarkers of neurological injury can potentially predict postoperative cognitive dysfunction. We aimed to identify whether classical neuronal damage-specific biomarkers, including brain fatty acid-binding protein, neuron-specific enolase and S100 calcium-binding protein β, as well as plasma-free haemoglobin concentration as a measure of haemolysis, could be used to predict the risk of long-term cognitive decline after coronary artery bypass grafting with or without cardiopulmonary bypass. We assessed cognitive function using the CogState brief computerised cognitive test battery at 3 months and at 15 months after surgery...
December 17, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27955899/nasa-model-of-threat-and-error-in-pediatric-cardiac-surgery-patterns-of-error%C3%A2-chains
#16
Edward Hickey, Eric Pham-Hung, Yaroslavna Nosikova, Fredrik Halvorsen, Michael Gritti, Steven Schwartz, Christopher A Caldarone, Glen Van Arsdell
BACKGROUND: We introduced the National Aeronautics and Space Association threat-and-error model to our surgical unit. All admissions are considered flights, which should pass through stepwise deescalations in risk during surgical recovery. We hypothesized that errors significantly influence risk deescalation and contribute to poor outcomes. METHODS: Patient flights (524) were tracked in real time for threats, errors, and unintended states by full-time performance personnel...
April 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27938886/the-society-of-thoracic-surgeons-mitral-valve-repair-replacement-plus-coronary-artery-bypass-grafting-composite-score-a-report-of-the-society-of-thoracic-surgeons-quality-measurement-task-force
#17
J Scott Rankin, Vinay Badhwar, Xia He, Jeffrey P Jacobs, James S Gammie, Anthony P Furnary, Frank L Fazzalari, Jane Han, Sean M O'Brien, David M Shahian
BACKGROUND: The Society of Thoracic Surgeons (STS) Quality Measurement Task Force has developed a composite performance measure for mitral repair/replacement (MVRR) with concomitant coronary artery bypass grafting (CABG). METHODS: Data were acquired from the STS Adult Cardiac Surgery Database for 26,463 patients undergoing MVRR + CABG operations between July 1, 2011, and June 30, 2014. Established STS risk models were applied, along with modifications enabling the inclusion of patients with concomitant closures of atrial septal defects and patent foramen ovale, surgical ablation for atrial fibrillation, and tricuspid valve repair (TVR)...
December 6, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27923485/randomized-multicenter-trial-comparing-sternotomy-closure-with-rigid-plate-fixation-to-wire-cerclage
#18
Keith B Allen, Vinod H Thourani, Yoshifumi Naka, Kendra J Grubb, John Grehan, Nirav Patel, T Sloane Guy, Kevin Landolfo, Marc Gerdisch, Mark Bonnell, David J Cohen
OBJECTIVE: To evaluate sternal healing, complications, and costs after sternotomy closure with rigid plate fixation or wire cerclage. METHODS: This prospective, single-blinded, multicenter trial randomized 236 patients at 12 US centers at the time of sternal closure to either rigid plate fixation (n = 116) or wire cerclage (n = 120). The primary endpoint, sternal healing at 6 months, was evaluated by a core laboratory using computed tomography and a 6-point scale (greater scores represent greater healing)...
November 17, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27922523/a-simple-and-effective-technique-for-anatomical-approximation-of-the-upper-pericardium-using-hemostatic-clips
#19
Mubassher Husain, Metesh Nalin Acharya, Ian Cummings, Shahzad Gull Raja
Closure of the pericardium is important to protect bypass grafts, the great vessels, and the heart from injury due to sternal dehiscence. Furthermore, it is reported to reduce the formation of pericardial adhesions and thus facilitate entry into the chest at resternotomy. We here describe a simple, reproducible, and effective technique for tension-free approximation of the upper pericardium by applying small hemostatic clips to the preserved thymic fascia overlying the pericardium.
November 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27913736/additional-effects-of-topical-tranexamic-acid-in-on-pump-cardiac-surgery
#20
RANDOMIZED CONTROLLED TRIAL
Noppon Taksaudom, Sophon Siwachat, Apichat Tantraworasin
Objective Postoperative bleeding after cardiac surgery is commonly associated with hyperfibrinolysis. This study was designed to evaluate the efficacy of topical tranexamic acid in addition to intravenous tranexamic acid in reducing bleeding in cardiac surgery cases. Methods From July 1, 2014 to September 30, 2015, 82 patients who underwent elective on-pump cardiac surgery were randomized into a tranexamic acid group and a placebo group. In the tranexamic acid group, 1 g of tranexamic acid dissolved in 100 mL of normal saline solution was poured into the pericardium during sternal closure; the placebo group had 100 mL of saline only...
January 2017: Asian Cardiovascular & Thoracic Annals
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